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Risk Analysis Manager

  • Ref: 304258
  • Type: Direct Hire
  • Location: New York, NY
  • Industry: Healthcare
  • Job Level: Senior
  • Pay: $130,000.00 - 150,000.00 plus Bonus

Opportunity Description

Our client is hiring a Risk Analysis Manager in New York, New York. In this role, you will be serving a critical role by working with both internal and external constituencies to ensure that the data for their membership is complete and accurate. The Risk Adjustment & Encounters Reporting team is unique, as it relies on establishing work streams and developing partnerships across the care continuum to ensure the accuracy and completeness of the data before it is submitted to the Centers for Medicare & Medicaid Services, and the New York State Department of Health. This position offers between $130,000-$150,000 annually depending on experience, excellent benefits including a 10% bonus, remote work with eventual meetings, and training in their beautiful offices in downtown Manhattan.

 

Job Duties

As the Risk Analysis Manager, you will:

  • Assume ownership of encounter data submission initiatives for medical, pharmacy, and ancillary data among all products.
  • Maintain cross-departmental relationships such as Information Systems, Claims, Enrollment, and other departments to enhance the quality of data submissions.
  • Be responsible for all financial reconciliation of encounter data and providing monthly reporting that exhibits the submission process is within control.
  • Lead initiatives to improve risk scores and revenue maximization. Assessing potential ROI opportunities and presenting findings to a broader audience.
  • Be responsible for developing requirements, reviewing specifications, creating test plans, and reviewing user-acceptance test data

Education

 

 

Experience & Skills Required

Qualifications:

  • Bachelor’s or Master’s degree in Healthcare Administration or Finance
  • Previous work experience within the Healthcare Industry with risk adjustment (Managing vendors, operating work-streams) or Analytics (Hospitals, IPAs, Healthcare vendors)
  • Experience using Data Visualization tools like Tableau, Qlik View, Power BI
  • Understanding of Medicaid/Medicare & ACA program
  • Proven ability to utilize and transform business data to deliver prescriptive guidance
  • Ability to communicate effectively across multiple functional areas within an organization
  • Proficiency in Advanced Excel (Pivot Tables, Complex formula construction)
  • Proficiency in SQL (Joins, Organic Scripting) – Utilizing any of the following tools (PostGres SQL – Tableau, SAS Studio)

Other Information

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